CPT code 91112 is a code used to describe the procedure for a GI wireless capsule measurement, aiding in digestive health assessments.
CPT code 91112 is for a gastrointestinal (GI) wireless capsule measurement. This procedure involves the use of a small, pill-sized camera that the patient swallows. The capsule captures images of the digestive tract as it passes through, allowing healthcare providers to assess conditions such as gastrointestinal bleeding, tumors, or other abnormalities in the small intestine. This non-invasive method provides valuable diagnostic information without the need for more invasive procedures.
When billing for the CPT code 91112 (Gi wireless capsule measure), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to increased complexity or difficulty.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed, such as the interpretation of the results.
3. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the procedure on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
12. Modifier 99 - Multiple Modifiers
- Apply this modifier if more than one modifier is necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies to confirm the appropriate use of modifiers.
The CPT code 91112, which refers to a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC) to confirm any specific local coverage determinations or additional guidelines that may affect reimbursement for CPT code 91112.
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